Alterations of erythropoiesis in Covid-19 patients: prevalence of positive Coombs tests and iron metabolism.
Coombs test
Covid-19
anemia
hemolysis
iron metabolism
Journal
Therapeutic advances in hematology
ISSN: 2040-6207
Titre abrégé: Ther Adv Hematol
Pays: England
ID NLM: 101549589
Informations de publication
Date de publication:
2023
2023
Historique:
received:
09
12
2022
accepted:
18
08
2023
medline:
2
10
2023
pubmed:
2
10
2023
entrez:
2
10
2023
Statut:
epublish
Résumé
For more than 2 years medical practice has been dealing with the Covid-19 pandemic. Atypical symptoms, such as frostbites and acrosyndromes, have appeared, and autoimmune anemias (some of which with cold agglutinins) have been described. We planned to study the prevalence of positive direct Coombs tests (DCTs) and hemolytic autoimmune anemia in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its correlation with complications, and then investigate the impact of the infection on iron metabolism. This is an observational, cross-sectional, single-center, exploratory study. We obtained Coombs tests in a population of 179 infected patients at the CHU of Liège. We then studied iron metabolism in some of these patients, by measuring serum ferritin, erythropoietin (EPO), erythroferrone and hepcidin. We did not identify any case of autoimmune hemolysis. However, there was a 20.3% prevalence of positive DCT, mainly with IgG (91.7%). These patients, compared to DCT-negative patients, were not only more anemic and transfused, but also required more transfers to intensive care units and had longer hospital stays and mechanical ventilation. The pattern of anemia was consistent with the anemia of inflammation, showing elevated hepcidin and ferritin levels, while EPO and erythroferrone values were lower than expected at this degree of anemia. Erythroferrone was higher and Hb was lower in DCT-positive patients. Finally, we identified a correlation between iron parameters and complicated forms of infection. Covid-19 patients suffered from inflammatory anemia with more severe forms of infection correlated to positive DCT status. This could potentially be of interest for future clinical practice.
Sections du résumé
Background
UNASSIGNED
For more than 2 years medical practice has been dealing with the Covid-19 pandemic. Atypical symptoms, such as frostbites and acrosyndromes, have appeared, and autoimmune anemias (some of which with cold agglutinins) have been described.
Objectives
UNASSIGNED
We planned to study the prevalence of positive direct Coombs tests (DCTs) and hemolytic autoimmune anemia in patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its correlation with complications, and then investigate the impact of the infection on iron metabolism.
Design
UNASSIGNED
This is an observational, cross-sectional, single-center, exploratory study.
Methods
UNASSIGNED
We obtained Coombs tests in a population of 179 infected patients at the CHU of Liège. We then studied iron metabolism in some of these patients, by measuring serum ferritin, erythropoietin (EPO), erythroferrone and hepcidin.
Results
UNASSIGNED
We did not identify any case of autoimmune hemolysis. However, there was a 20.3% prevalence of positive DCT, mainly with IgG (91.7%). These patients, compared to DCT-negative patients, were not only more anemic and transfused, but also required more transfers to intensive care units and had longer hospital stays and mechanical ventilation. The pattern of anemia was consistent with the anemia of inflammation, showing elevated hepcidin and ferritin levels, while EPO and erythroferrone values were lower than expected at this degree of anemia. Erythroferrone was higher and Hb was lower in DCT-positive patients. Finally, we identified a correlation between iron parameters and complicated forms of infection.
Conclusion
UNASSIGNED
Covid-19 patients suffered from inflammatory anemia with more severe forms of infection correlated to positive DCT status. This could potentially be of interest for future clinical practice.
Identifiants
pubmed: 37780945
doi: 10.1177/20406207231199837
pii: 10.1177_20406207231199837
pmc: PMC10540584
doi:
Types de publication
Journal Article
Langues
eng
Pagination
20406207231199837Informations de copyright
© The Author(s), 2023.
Déclaration de conflit d'intérêts
The author declares that there is no conflict of interest.
Références
Br J Haematol. 2020 Aug;190(4):e183-e184
pubmed: 32460350
Immunobiology. 2021 May;226(3):152093
pubmed: 34022670
Hemasphere. 2020 Nov 10;4(6):e492
pubmed: 33205000
Exp Hematol. 2001 Jun;29(6):677-85
pubmed: 11378262
Am J Hematol. 2021 Oct 1;96(10):1275-1286
pubmed: 34310730
Transl Res. 2020 Jun;220:1-13
pubmed: 32299776
Circulation. 2020 Jun 2;141(22):1739-1741
pubmed: 32271624
Eur J Epidemiol. 2020 Aug;35(8):763-773
pubmed: 32816244
Hematol Oncol Stem Cell Ther. 2022 Dec 23;15(4):213-216
pubmed: 32645300
Blood. 2020 Aug 6;136(6):655-656
pubmed: 32761221
Nat Genet. 2014 Jul;46(7):678-84
pubmed: 24880340
Am J Hematol. 2021 Jan;96(1):E32-E35
pubmed: 33075189
Front Immunol. 2020 Apr 07;11:590
pubmed: 32318071
Immunobiology. 2022 Jul;227(4):152240
pubmed: 35839729
Blood. 2019 Jan 3;133(1):40-50
pubmed: 30401705
Clin Exp Med. 2021 May;21(2):239-246
pubmed: 33417082
Br J Haematol. 1999 Sep;106(3):752-5
pubmed: 10468869
Ann Hematol. 2021 Jan;100(1):37-43
pubmed: 32918594
Med Microbiol Immunol. 2021 Jun;210(2-3):101-109
pubmed: 33811541
BMJ. 2007 Oct 20;335(7624):806-8
pubmed: 17947786
mBio. 2018 Oct 9;9(5):
pubmed: 30301856
Med Sci Monit. 2020 Sep 26;26:e926178
pubmed: 32978363
Dermatol Ther. 2020 Sep;33(5):e13430
pubmed: 32314460
Eur J Case Rep Intern Med. 2021 Mar 10;8(3):002387
pubmed: 33987115
Blood. 2020 Aug 6;136(6):766-768
pubmed: 32559762
Br J Haematol. 2020 Jul;190(1):29-31
pubmed: 32374906
N Engl J Med. 2020 Apr 30;382(18):e43
pubmed: 32294340
Am J Hematol. 2022 Nov;97(11):1404-1412
pubmed: 36215667
Haematologica. 2014 Mar;99(3):e35-7
pubmed: 24441148
Wellcome Open Res. 2022 Jun 21;7:173
pubmed: 35935705